Setting the Stage: Research to Inform Interventions, Practice and Policy to Improve Women Veterans’ Health and Health Care

Bastian, Lori A.; Bosworth, Hayden B.; Washington, Donna L.; Yano, Elizabeth M.

doi:10.1007/s11606-013-2470-9

Cited by 11 publications

(9 citation statements)

References 20 publications

(15 reference statements)

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“…37,38 Research-clinical partnerships may also help accelerate testing of innovative approaches to delivering the fundamental tenets of PACT to special populations, bringing evidence-based approaches to bear on these issues. [39][40][41] Key lessons may yield insights for ensuring that all veterans equitably benefit from the promise of PACT.…”

Section: Resultsmentioning

confidence: 99%

Delivery of Gender-Sensitive Comprehensive Primary Care to Women Veterans: Implications for VA Patient Aligned Care Teams

2014

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The Veterans Health Administration (VA) has undertaken a major initiative to transform primary care delivery through implementation of Patient Aligned Care Teams (PACTs). Based on the patient-centered medical home concept, PACTs aim to improve access, continuity, coordination, and comprehensiveness using teambased care that is patient driven and patient centered. However, how PACT principles should be applied to meet the needs of special populations, including women veterans, is not entirely clear. While historical differences in military participation meant women veterans were rarely seen in VA healthcare settings, they now represent the fastest growing segment of new VA users. They also have complex healthcare needs, adding gender-specific services and other needs to the spectrum of services that the VA must deliver. These trends are changing the VA landscape, introducing challenges to how VA care is organized, how VA providers need to be trained, and how VA considers implementation of new initiatives, such as PACT. We briefly describe the evolution of VA primary care delivery for women veterans, review VA policy for delivering gender-sensitive comprehensive primary care for women, and discuss the challenges that women veterans' needs pose in the context of PACT implementation. We conclude with recommendations for addressing some of these challenges moving forward.KEY WORDS: primary care; women's health; veterans.

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Section: Resultsmentioning

confidence: 99%

Delivery of Gender-Sensitive Comprehensive Primary Care to Women Veterans: Implications for VA Patient Aligned Care Teams

2014

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“…For example, Figure 1 reveals changes in the proportion of women veterans by age group over the years of observation, and highlights the ability to examine pain among women veterans across the age span. [3] Future analyses may examine clinical characteristics that are unique and reliably discriminate women from men within specific age ranges. Given the large and comprehensive nature of the MSD cohort, there are many additional opportunities to examine, for example, pain among veterans aged 85 and over, correlates of specific MSD such as temporomandibular disorders, variation in trajectories of pain by facility, the use of and outcomes associated with non-pharmacologic pain treatments.…”

Section: Discussionmentioning

confidence: 99%

The musculoskeletal diagnosis cohort: examining pain and pain care among veterans

Goulet

Kerns

Bair

et al. 2016

Pain

132

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Musculoskeletal disorders (MSD) are highly prevalent, painful, and costly disorders. The MSD Cohort was created to characterize variation in pain, comorbidities, treatment, and outcomes among patients with MSD receiving Veterans Health Administration (VHA) care across demographic groups, geographic regions, and facilities. We searched electronic health records to identify patients treated in VHA who had ICD9-CM codes for diagnoses including, but not limited to, joint, back and neck disorders, and osteoarthritis. Cohort inclusion criteria were two or more outpatient visits occurring within 18 months of one another or one inpatient visit with an MSD diagnosis between 2000 and 2011. The first diagnosis is the index date. Pain intensity numeric rating scale (NRS) scores, comorbid medical and mental health diagnoses, pain-related treatments, and other characteristics were collected retrospectively and prospectively. The cohort includes 5,237,763 patients; their mean age was 59, 6% were women, 15% identified as Black, and 18% reported severe pain (NRS ≥ 7) on the index date. Non-traumatic joint (27%), back (25%) and osteoarthritis (21%) were the most common MSD diagnoses. Patients entering the cohort in recent years had more concurrent MSD diagnoses and higher NRS scores. The MSD cohort is a rich resource for collaborative pain-relevant health service research.

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“…The VA's commitment to ensuring equitable access to highquality health care for women veterans has stimulated a surge in research on women veterans' health and health care issues (Bastian, Bosworth, Washington, & Yano, 2013;Yano et al, 2011). A review of women veterans' health research published between 2004 and 2008 revealed that more articles were published within that 5-year period than during the 25 previous years ; the pace of research increased further from 2008 through 2015 (Danan et al, 2017).…”

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confidence: 99%

Gender Differences in Demographic and Health Characteristics of the Million Veteran Program Cohort

Program

2019

Women's Health Issues

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a b s t r a c tBackground: The Department of Veterans Affairs Million Veteran Program (MVP) is the largest ongoing cohort program of its kind, with 654,903 enrollees as of June 2018. The objectives of this study were to examine gender differences in the MVP cohort with respect to response and enrollment rates; demographic, health, and health care characteristics; and prevalence of self-reported health conditions. Methods: The MVP Baseline Survey was completed by 415,694 veterans (8% women), providing self-report measures of demographic characteristics, health status, and medical history. Results: Relative to men, women demonstrated a higher positive responder rate (23.0% vs. 16.0%), slightly higher enrollment rate (13.5% vs. 12.9%), and, among enrollees, a lower survey completion rate (59.7% vs. 63.8%). Women were younger, more racially diverse, had higher educational attainment, and were less likely to be married or cohabitating with a partner than men. Women were more likely to report good to excellent health status but poorer physical fitness, and less likely to report lifetime smoking and drinking than men. Compared with men, women veterans showed an increased prevalence of musculoskeletal conditions, thyroid problems, gastrointestinal conditions, migraine headaches, and mental health disorders, as well as a decreased prevalence of gout, cardiovascular diseases, high cholesterol, diabetes, and hearing problems. Conclusions: These results revealed some substantial gender differences in the research participation rates, demographic profile, health characteristics, and prevalence of health conditions for veterans in the MVP cohort. Findings highlight the need for tailoring recruitment efforts to ensure representation of the increasing women veteran population receiving care through the Veterans Health Administration.Published by Elsevier Inc. on behalf of Jacobs Institute of Women's Health. Migraine headaches 2.27 (2.22-2.31)Osteoarthri s 1.94 (1.90-1.98) Asthma 1.91 (1.86-1.96) Bipolar disorder 1.43 (1.37-1.49) Anxiety reac on/ panic disorder 1.39 (1.37-1.42) Depression 1.38 (1.37-1.40) Other headaches 1.38 (1.34-1.42) Skin cancer 0.81 (0.78-0.84) Hypertension 0.78 (0.77-0.79) Diabetes 0.75 (0.73-0.77) Sleep apnea 0.64 (0.62-0.65) Trauma c brain injury 0.63 (0.60-0.67) Tinnitus 0.62 (0.61-0.63) Hearing loss 0.49 (0.47-0.50) Coronary artery/heart disease 0.43 (0.41-0.46) Heart a ack 0.40 (0.38-0.43) Gout 0.31 (0.29-0.34) Risk Ra o Figure 2. Age-standardized risk ratios (RRs) and 95% confidence intervals of self-reported health conditions for women versus men enrolled in the Million Veteran Program (using men as the reference group). This figure displays the top 10 conditions associated with elevated risk for women and the top 10 conditions associated with reduced risk for women (the 10 largest and 10 smallest RRs, respectively). IBS, irritable bowel syndrome.K.M. Harrington et al. / Women's Health Issues 29-S1 (2019) S56-S66 S62

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Setting the Stage: Research to Inform Interventions, Practice and Policy to Improve Women Veterans’ Health and Health Care

Cited by 11 publications

References 20 publications

Delivery of Gender-Sensitive Comprehensive Primary Care to Women Veterans: Implications for VA Patient Aligned Care Teams

Delivery of Gender-Sensitive Comprehensive Primary Care to Women Veterans: Implications for VA Patient Aligned Care Teams

The musculoskeletal diagnosis cohort: examining pain and pain care among veterans

Gender Differences in Demographic and Health Characteristics of the Million Veteran Program Cohort

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